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Episiotomy Medical Negligence

How To Avoid An Episiotomy

If you are due to give birth, is there anything that you can do to avoid an episiotomy and the associated episiotomy pain? What action can you take, or what questions can you ask your medical team, to help you avoid an episiotomy? This article explores your options so that you can ask the right questions at the right times.

What Is An Episiotomy?

If you are giving birth naturally and the medical team are using forceps or ventouse to deliver baby, or perhaps there are signs that your baby is in distress, the medical team may decide to perform an episiotomy to improve the speed of delivery of the baby. The episiotomy is a small cut through the skin and muscle to the area known as the perineum (the area from the vagina towards the anus). This is quite a common occurrence with as many as 14% of women giving birth naturally having an episiotomy. However, over the years the medical profession have tried to move away from episiotomies.

Why Avoid An Episiotomy?

There are various reasons why someone would like to avoid an episiotomy, including:

  • It is a performed cut through the skin and muscle, so will require stitching and time to heal. This will make it difficult for a new mother to be as mobile as she might like to be when caring for her newborn child;
  • The wound might become infected leading to complications and increased pain and suffering; or
  • The episiotomy can tear further than the initial cut, even as far as the anus, causing additional pain and discomfort, and in extreme cases, even incontinence.

It is clear that the possible side effects of an episiotomy can be grave which is why so many mothers are keen to avoid it.

How To Avoid An Episiotomy.

During pregnancy you can carry out pelvic floor muscles to learn how to tighten and relax your pelvic floor muscles. During labour you need to be able to relax your pelvic floor muscle (whereas the natural reaction is to tense it). Practising this will make it easier for you to relax your pelvic floor muscle during labour.

You can also start practising a perineal massage from around 34 weeks of pregnancy. This can improve the elasticity of your perineum which again will reduce the likelihood of tearing and can therefore reduce the need for an episiotomy. To carry out a perineal massage use an oil or water soluble jelly (not mineral oil or petroleum jelly but vegetable or wheat germ oil, or K-Y Jelly will work) and place your thumb inside your vagina. Starting from a third of the way up on one side of the vagina, move your thumb slowly down this side, across the bottom of the vagina and then halfway up the other side, gently stretching your vagina as you do this. Relax as you do this and as you become more comfortable with it push a little harder until you feel a tingling or stinging sensation (but do not push any harder once you feel this). You should perform this perineal massage for five to ten minutes a day from the 34th week of pregnancy.

You should also discuss your desire to avoid an episiotomy with your midwife and the birth team at the hospital and make it clear that you want to work with them to avoid an episiotomy or a birth tear.

Many episiotomies are carried out because during birth the woman is exhausted and unable to carry on in labour for much longer. Therefore, it is important to conserve energy in the early stages of labour and ensure that you consume enough and the right type of food and liquid. Speak with your midwife about this.

One you are well into labour, you will feel the baby crowning as a stinging or burning pain. This is when you should talk with your midwife and ensure you push at the right times. Try and explain the pain you are experiencing so that you know when to push and when to rest.

Summary.

There are clearly good reasons why you would like to avoid an episiotomy. Talk through your desires with your midwife in the early stages of pregnancy and ask her to demonstrate how you can carry out a perineal massage and how you can work with her during the birth to avoid an episiotomy.

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